The staff at ABCS RCMS (Advanced Billing and Consulting Services) has put together seven common modifiers that are often encountered when delivering medical billing services. Modifiers in healthcare billing are used for a variety of reasons. Some of the main reasons are as follows:
- Some claims are incomplete or inaccurate.
- Some claims need a higher level of code specificity in order to properly submit the claim.
- A modifier’s proper use can lower a medical practitioner’s claim denial rate.
- The correct use of a modifier can increase the rate of reimbursement from the insurance provider.
These are the details that allow ABCS RCM to offer experienced medical billing services to our customers. Modifiers become even more complex, with Level I Modifiers (CPT) updated by the AMA and Level II Modifiers (CMS) updated by the CMS.
The following list is by no means exhaustive, but here are 7 common medical billing modifiers:
Modifier 24 = Unrelated E/M service by the same doctor during a post-operative period.
Modifier 25 = (Very common) The medical provider did extra work on the spot.
Modifier 26 = Technical component (TC). There is both a professional and technical component to this procedure.
Modifier 27 = (Not as common) Patient has multiple visits on the same day, by the same or different physician.
Modifier 51 = Multiple procedures by the same provider at the same session.
Modifier 59 = Linked services by the medical provider.
Modifier 76 = Repeated by the same medical provider on the same day, but separate sessions (excluding surgical codes).
If modifiers are missing or not used correctly, claims are quickly denied or rejected by insurance payers. Healthcare practices will suffer from aged accounts, write-offs and revenue leakage if they do not have a firm grasp on the proper use of modifiers.
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Common Medical Billing Modifiers, Revenue Leakage, ABCSrcm, Aged Accounts